Disability Identity Formation and Affirmation: The Experiences of Persons with Severe Mental Illness

This article examines the pervasive nature and extent of the debilitating sense of shame associated with disability. It then explores the emergence of disability identity, pride, and culture to challenge such shame—illustrated in personal narrative accounts of the individual and collective journeys of people coping with severe mental illness.     

Family Intervention and Services for Persons with Mental Illness in the People's Republic of China

ABSTRACT

Family services and intervention for persons with mental illness is crucial in mental health services. In this paper, the writer attempts to describe family intervention and services for persons with mental illness in the People's Republic of China. Family intervention and services like home-based care, guardianship network, family counseling, and psychoeducational programs are only preliminarily developed. Their effectiveness and challenges in future development are discussed.     

The Emergence and Attributes of Second-Generation Community Support Systems for Persons with Serious Mental Illness

Abstract

This paper examines the original model of community support for people coping with psychiatric disabilities and illuminates four emergent factors that are bringing about what the author identifies as second-generation community support systems. The author discusses the important role of recovery in refraining the purpose and aims of second-generation community support systems and draws implications for how case management can function within these systems to make them more responsive to recipients.     

Mental Illness in Assisted Living: Challenges for Quality of Life and Care

ABSTRACT

An unknown number of mentally ill elders in the United States receive care in assisted living, along with persons facing physical or cognitive challenges. While dementia is familiar in assisted living, our data indicate that neither staff nor residents are prepared to work or live with the mentally ill. Challenges are created for professionals, since these residents bring diverse needs. Daily interresident interactions are also disrupted or stressful. Qualitative data describe the impacts on quality of resident life as well as care and management dilemmas identified within five assisted-living settings having varying presence of mental illness among residents.     

Business Incubation for People with Severe Mental Illness Histories: The Experience of One Model

ABSTRACT

The Enterprise People was a business incubator for people with serious mental health conditions that operated in Madison, Wisconsin, from 1998–2005. It supported entrepreneurs with learning basic business skills, start-up processes and expenses, back office supports, ongoing problem solving, and for some, with space to conduct their businesses. The original impetus was to discover whether people with SMI histories could successfully start and operate small businesses. Although this was confirmed, the experience also uncovered factors that will allow other projects of this sort to succeed, and some core infrastructural supports that need to be created. The experience demonstrates that self-employment supported by formal business incubation is a viable option in the range of mental health vocational rehabilitation models.     

Differential Labeling of Mental Illness Revisited: Patterns Before and After the Rise of Managed Care

With the National Comorbidity Survey of the early 1990s, Thoits (2005) recently showed that lower-status mentally ill individuals were not more often hospitalized or pressured into psychiatric treatment than comparably ill persons of higher status, disconfirming a central hypothesis of labeling theory. However, that finding may have been due to changes in the mental health treatment system introduced by the spread of managed care. The differential labeling hypothesis is reexamined here with data from the Epidemiological Catchment Area Studies (ECA) collected in the early 1980s before managed-care plans began to dominate the insurance marketplace and from the National Comorbidity Survey Replication conducted in the early 2000s when managed care had saturated the market. Little systematic support for the differential labeling hypothesis was found in the three studies, although, over time, the higher rates of mental hospitalization among less educated and low-income individuals found in the ECA survey disappeared. Trends across the studies suggest that educated and affluent persons with psychiatric problems more frequently sought hospital care. These findings further undermine the validity of the differential labeling hypothesis and suggest that service utilization or treatment-seeking factors may help explain mental hospitalization rates.     

Working with Families Who Experience Parental Mental Health and/or Drug and Alcohol Problems in the Context of Child Protection Concerns: Recommendations for Service Improvement

Child abuse and neglect often occur within the context of multiple risk factors, in particular parental mental health (MH) and/or drug and alcohol (D&A) problems. Interventions aimed at improving parental MH and D&A issues can have a positive impact on children now, as well as in the future. However, implementing sustainable service models that facilitate positive change for families with multiple risk factors is challenging. The purpose of the present study was to gain feedback from key stakeholders on a service model targeted at families where there are parental D&A, MH and child protection concerns to identify possible strengths and limitations of the model. This identified possible strategies for service improvement from the perspective of discharged clients and clinical staff. Gaining feedback from key stakeholders on service models is increasingly recognised as central to service evaluation and development. Ten interviews were conducted with clinical staff and twenty interviews with discharged clients of a pilot service that works with families where the child or children are at risk of significant harm in the context of parental MH and/or D&A issues. The interviews with clinicians highlighted difficulties working with this complex client group and its impact on staff burnout. Clinicians suggested how the model could be changed to better support clinical staff from burnout. Interviews with discharged clients highlighted the importance of the relationship with the worker in establishing client engagement and facilitating change. The way in which these recommendations informed the design of the service model is discussed.     

Space,People, Interventions and Time (SPIT): A Model for Understanding Children's Outdoor Play in Post‐Disaster Contexts Based On a Case Study from the Triple Disaster Area of Tohoku in North‐East Japan

Play in the outdoor environment is important for children as part of their childhood and is particularly important for children in a post‐disaster situation. This article explores issues around outdoor play opportunities in the Tohoku region of north‐east Japan, 13 months after the triple disaster of earthquake, tsunami and nuclear power plant failure. A model of space, people, interventions and time (SPIT) is used to understand the situation in this unique case study.